POS0657 SURVIVAL OF BARICITINIB VS ANTI-TNF AS THE FIRST BIOLOGICAL DRUG IN PATIENTS WITH RHEUMATOID ARTHRITIS, IN CLINICAL PRACTICE: RESULTS OF A LOCAL REGISTRY
Authors: J. Rosas, A. Pons, X. Barber, J. M. Senabre-Gallego, G. Santos Soler, E. Soler-Giner, J. A. Bernal, A. Raga, C. Raya-Santos, J. C. Cortés-Quiroz, M. Lorente Betoret, J. A. García-Gómez
Journal: Annals of the Rheumatic Diseases (2022)

Objectives To evaluate survival in the first 4 years of treatment with Baricitinib (BARI) vs anti-TNF (TNFi), as the first biological drug (BIO-1), in patients with rheumatoid arthritis (RA). Methods Retrospective study of patients with RA, treated with the first BIO-1, with BARI or TNFi, from September-2017 to December-2021. General data (current age, at diagnosis of RA and at the start of BIO-1) were collected; RA: evolution time, RF, ACPA; type of BIO-1: dose received, time in treatment, reason for withdrawal. Univariate analysis of drug survival was performed using Kaplan-Meyer curves and the Long Rank test to differentiate by groups. For the multivariate study, Cox regression with proportional hazards. Results The study includes 96 patients with RA, who have started treatment for &gt; 1 month with BIO-1: BARI (n: 63/66% patients) or TNFi (33/34% patients): women: 82 (96%), current mean age (SD): 62 (1) years, at diagnosis: 51 (1) years and at the start of BIO-1: 59 (1) years. 36 (37%) patients are ≥65 years old, the mean time in AR is 7.6 years and the time in BIO-1: 1.34 (2.2) years. BIO-1 was withdrawn in 34 (40%) patients: Inefficacy: 17 (18%) patients, Complications: 14 (15%) [Cardiovascular/thrombosis: 2 (2%), rash: 2 (2%), infection-neoplasia-immunogenicity: 1 (1%) patient in each], loss to follow-up: 5 (5%) and others: 2 (2%). When comparing the BARI vs. TNFI group, no differences were detected between the general data, the percentage of patients &gt;65 years of age, or the mean time in treatment or the reasons for drug withdrawal (Table 1). However, survival in the BARI group was significantly superior to TNFi throughout the period (p=0.04; HR: 0.47, 95% CI: 0.24-0.91, p=0.026) (Figure 1A). Table 1. Characteristics of patients who receive Baricitinib (BARI) or anti-TNF as first BIO-1 (TNFi). AllN: 96 BARIN: 63 (66%) TNFiN: 33 (34%) P Female, n (%) 82 (85%) 56 (89) 26 (79) 0.2 Current age, mean (SD) 62 (4.2) 63 (6) 59 (11) 0.057 Age at diagnosis RA, mean (SD) 51 (4.9) 52.5 (7.8) 48.6 (15.5) 0.17 Age at start of BIO-1, mean (SD) 59 (2.1) 60 (4.9) 55.9 (9.9) 0.23 ≥ 65 years, n (%) 36 (37) 27 (43) 9 (27) 0.39 RF positive, n (%) 77 (80) 54 (86) 23 (70) 0.1 ACPA positive, n (%) 74 (77) 50 (79) 24 (73) 0.56 Average time in BIO-1, years (DE) 1.34 (2.2) 1.85 (0.5) 1.32 (2.4) 0.21 BARI 2 mg, n (%) - 23 (36) - - Withdrawal of BIO-1, n (%): 38 (40) 20 (32) 18 (55) 0.15 - Complication 14 (15) 7 (13) 7 (21) - - Loss of efficacy 17 (18) 8 (13) 9 (27) - - Loss of follow up 5 (5) 5 (8) - - - Other 2 (2) - 2 (6) - Figure 1. Survival probability in patients with rheumatoid arthritis who receive the first BIO-1. A . Between TNFi drug vs Baricitinib. B . Between TNFi vs Baricitinib 2 mg or 4 mg. In patients &lt;65 years, the greatest survival of BARI is maintained (p=0.05), being significant in the first 24 months of treatment (p=0.02). In patients ≥65 years, significance was not reached throughout the overall period (p=0.5) and in the first 24 months of treatment (p=0.06). When comparing the BARI 2 mg (n: 23/36%) and 4 mg (n: 40/64%) groups, the 2 mg group is significantly older at RA diagnosis (73 [SD: 2] years vs 56 [SD: 3] years; p&lt;0.0001) and at the start of BIO-1 (72 [SD: 1.4] years vs 54 [SD: 2.8] years; p&lt;0.0001). However, survival in the BARI 2 mg group was significantly higher in the first 24 months (p=0.003;) (Figure 1B): BARI 2 mg HR: 0.14, 95% CI; 0.04-0.56, p=0.005, HR BARI 4 mg: 0.44 (95% CI; 0.20-0.96, p=0.038). Conclusion 1. Survival of BARI is superior to TNFi during the first 4 years of treatment, especially during the first 24 months of treatment. 2. There are no differences between the cause that causes drug withdrawal. 3. The use of the 2 mg dose of BARI predominates in patients older than 65 years, with survival being greater than TNFi, especially in the first 24 months of treatment. Acknowledgements The study was supported by a research grant from the Marina Baixa Association for Research in Rheumatology (AIRE-MB). Disclosure of Interests None declared